Just-in-time adaptive interventions and chronic disease management

Just-in-time adaptive intervention (JITAI) is an emerging intervention method that can promote healthy behaviors and prevent unfavorable health-related behaviors. JITAIs use real-time data to deliver the right amount of support to individuals at the right time via mobile applications. The method uses mobile computers, sensors, and software analytics to detect behaviors and create personalized behavior interventions.

In a study, researchers from the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University examined the behavioral response to JITAI for reducing sedentary behavior (SB) in overweight and obese individuals. The study consisted of thirty participants with a mean body mass index of 36.2 kg/m2, and involved participants receiving mobile phone prompts to take walking breaks after 30, 60, or 120 SB minutes. The duration of the walking breaks differed for each of the three conditions. The breaks lasted three, six, and twelve minutes, respectively.

After an average of 6.90 days, there were significant reductions in time spent in SB in each of the three conditions. Time spent in light intensity and moderate to vigorous intensity also improved. The best adherence to prompts, greatest number of walking breaks, and greatest amount of time spent in walking breaks per day occured in the three and six minute conditions. The app was effective in promoting breaks in SB at the most clinically relevant times. JITAI and other behavioral health interventions have potential to change the way diseases and treated and prevented.

How effective is Mobile Health Coaching?

Nutrition care providers and consumers are turning to mobile health coaching to help manage chronic conditions, including diabetes, high blood pressure, and obesity. Obesity is prevalent and costly for health care systems. As of 2014, 71% of Americans are overweight, while 35% of men and 40% of women in the US are obese. In a study, researchers evaluated a mobile health coaching intervention for its effectiveness in helping participants lose weight and lower their blood pressure. The study participants were overweight adults with a body mass index of at least 25 kg/m2. Participants received intensive health coaching over the phone, through video, and through in-app text messaging over the course of four months.

A total of 1127 people downloaded the mobile health coaching application initially, and 1012 participants completed the four months of coaching. After using the application for four months, participants lost 3.23% of total body weight, on average. Of the 763 participants with weight data, 218 people (28.6%) reached a clinically significant level of weight loss of 5% or more of total body weight. One hundred and fifty-one participants provided blood pressure information as well. Of these individuals, 112 (74.2%) had a baseline blood pressure above the goal, and 55 participants (49.1%) improved their blood pressure by one hypertensive stage. The study provides evidence that digital health coaching can be used to help overweight or obese individuals lose weight and manage blood pressure. It also suggests that the use of mobile health coaching can decrease entry barriers to receiving weight management care.

Mobile health coaching can be effective in improving a range of behaviors affecting a person’s health. Lifestyle behaviors including exercise, nutrition, alcohol use and smoking are some of the most common behaviors tied to the development of chronic health conditions. These behaviors are daily habits that determine the overall state of a person’s health. A team of researchers analyzed 13 studies that looked at the impact of health coaching on improving health. The results revealed better weight management, increased physical activity, and improved physical and mental health status. In another study, researchers analyzed 15 health coaching studies and saw that 40% of participants had significant outcomes in nutrition, physical activity, weight loss, and/or medication adherence. The most effective components of the health coaching studies were goal-setting, Motivational Interviewing, and collaboration with healthcare providers.

Mobile health coaching can be an effective means to help individuals change certain lifestyle behaviors and improve their quality of life. At Root Health, we use behavior science to help people change their habits, improve their health, and reduce the risk of chronic disease through mobile, patient centered health coaching.

The Rise of Mobile Health Coaching

Mobile Health Coaching could be an opportunity for your company.


In today's world, where we do not have control over everything that happens around us, many consumers are striving to feel some certainty in their lives by taking control of their health. At the start of 2017, a study revealed that the average stress level among Americans rose to an all-time high of 5.1 on a scale from 1 to 10. Consumers are facing increased anxiety, disrupted sleep, and fatigue, and are seeking solutions to improve their health and well-being.

Other consumers have different motivations to change their health-related behaviors. The CDC reveals that about half of all adults are living with one or more chronic health conditions such as heart disease, obesity, and diabetes. For many people, there are barriers to access necessary health interventions at the right time and place-- including difficulty attending in-person health coaching sessions due to lack of transportation, free time, childcare, and other factors. Fortunately, the use of telecommunication technologies in healthcare is breaking down these barriers. Sixty percent of Americans want health coaching, and mobile health coaching may be the perfect solution for those who are seeking a more convenient and personal healthcare coaching option.

As of 2015, over 83% of large companies offer disease management programs for their employees. Of these companies, 71% offer counseling over the phone or online, while only 36% offer in-person coaching.

Mobile health coaching is a method for Registered Dietitians to implement the Nutrition Care Process (nutrition assessment, diagnosis, intervention, and monitoring and evaluation) through the use of telecommunications technologies. It is an interactive process that takes place between RDs and patients via mobile devices. Mobile health coaching allows dietitians to consult with patients in real time through mobile phone apps, web-based video conferencing services, email, and other electronic communication methods. This is especially beneficial for patients who live in remote areas or those who do not have the means of transport to visit a dietitian’s office. Other patients either may not have the time to go to a dietitian, or they may go to a doctor’s office that does not have a Registered Dietitian on staff.         

Mobile health coaching benefits dietitians as well. Since the method is technology-based, mobile coaching allows your nutritionist staff the flexibility to provide real-time coaching from the office or at home. Nutritionists are also able to consult with patients who require immediate attention. Mobile health coaching also allows RNs to develop a more personal relationship with their patients by communicating privately over a messaging or video conferencing application. RNs and patients can communicate more frequently through mobile coaching than through traditional means, which allows nutritionists to better understand and help their patients.

The demand for mobile health coaching is on the rise for all types of healthcare consumers. At Root Health, we understand the need for this type of health coaching, which is why we offer a solution. Could digital health coaching be an asset to your practice?

Why we started Root Health

One out of every three Americans will die prematurely from a chronic disease condition that is mostly related to lifestyle and habit. Multiple studies have proven that lifestyle factors such as a healthy diet, exercise and sleep can control or reverse chronic disease. The National Center for Disease Control has called Chronic Disease the public health challenge of the 21st century.

We started Root Health because we want to reinvent healthcare. We believe the concept of healthcare is flawed. Today, patients perceive a lack of provider compassion, caring and understanding. They hurriedly meet their doctor and get generic advice. Clinicians themselves are frustrated by patient volume and their inability to provide support for their patients. In fact, the Association of American Medical Colleges project shortfalls of primary care physicians by 2030. What if every patient could get unlimited clinical support that is encouraging, understanding and motivating based on their individual lives?

At Root Health, we create digital tools that provide personalized care that enable lasting behavior change and improve the health of patients. Our approach is to use cutting edge technology to empower patients and care teams. We use behavior science to help people change their habits, improve their health and reduce the risk of chronic disease. Clinicians save lives – we give them super powers. We use clinically supported and evidence-based programs to create programs that are interactive and integrate seamlessly into patient lives. We empower patients to make the right decisions at the key moments and decision points. The Root Health App analyzes patient-specific contextual information such as location, activity, and sleep habits and serves as an intelligent health assistant to recommend dietary items, exercise, and sleep for patient specific chronic conditions.

Take for example “Greg”. Greg was pre-diabetic when we first met him. He was unsure about what he should eat, how to control his hunger, and whether or not he was getting enough exercise. Greg’s eating habits tended to change depending on his mood. There were days when he got upset and emotionally ate all day. Our Root Health team provided him constructive high value interventions when he needed to make a decision – like at the grocery store or when he went out to dinner with friends. For example, during his morning Starbucks routine, Root App provided advice for Greg so he could avoid sugary high calorie drinks. Throughout each day, Root App monitored Greg’s emotion, diet, and energy levels and adjusted its advice accordingly. If Greg needed an afternoon pick-me-up, Root provided him high value advice on what to eat for sustained energy until dinner time.

We believe that everyone should have affordable access to healthcare. We’re here at Root to reimagine healthcare and change lives.